Medicaid has been in the news over the past few weeks, as President Obama and members of Congress debate whether to make cuts to the federal-state program for the poor and disabled (and to other large entitlement programs) that could help reduce the federal deficit. GrantWatch Blog has gathered just a sampling of what foundations have recently funded regarding Medicaid, including academic research, an effort to educate congressional staffers about the program, and advocacy.
Let me start with the basics—the Alliance for Health Reform, a nonpartisan health policy education group, held a briefing in March called “Medicaid: A Primer on the Federal-State Partnership.” The Kaiser Commission on Medicaid and the Uninsured, part of the Henry J. Kaiser Family Foundation, cosponsored the event with the Alliance. Among the speakers was Cindy Mann of the Centers for Medicare and Medicaid Services (CMS). Clicking on the primer link above will get you to the webcast of the event and other resource materials.
New working paper
“The Oregon Health Insurance Experiment: Evidence from the First Year,” a July National Bureau of Economic Research (NBER) working paper, by Amy Finkelstein and coauthors, evaluates the effects of enrolling in Medicaid. The authors used a randomized controlled study design based on the state of Oregon’s lottery to allocate 10,000 spots in its Medicaid program to some of the 90,000 low-income, previously uninsured adults on a waiting list. Medicaid coverage resulted in substantively higher use of health care, lower out-of-pocket medical expenses and medical debt, and “better self-reported physical and mental health” relative to being uninsured. Jon Gruber, Joe Newhouse, and Katherine Baicker are among the numerous coauthors of this paper.
The authors point out that it is natural to try to generalize the results of this experiment to other contexts, including the planned 2014 Medicaid expansions under the Affordable Care Act. “Any such attempt comes with important caveats,” they state. (See pages 34–35.)
Funders of the study include the Robert Wood Johnson Foundation (RWJF); the John D. and Catherine T. MacArthur, Alfred P. Sloan, and Smith Richardson Foundations; the California HealthCare Foundation (CHCF); and various federal government agencies.
Other mentions of the working paper:
I found the CHCF’s summary of this study a bit easier to understand (for the layperson) than the research paper itself, which is written for a high-level audience. The foundation succinctly provides some context: Some 90,000 low-income adults on a waiting list applied for the approximately 10,000 openings in Oregon Medicaid back in 2008, and “this overwhelming response” enabled the authors of the NBER working paper “to conduct the first randomized controlled study of insuring previously uninsured adults.” The CHCF has bullet points of some key study findings discovered after the 10,000 adults had been enrolled in Oregon Medicaid for almost a year. For example, the study found that having such Medicaid coverage increased the probability of having a regular physician office or clinic for primary care by 70 percent. However, having Medicaid coverage did not reduce emergency department use, and the researchers also found that annual health expenses increased by 25 percent, “underscoring the vital importance of finding ways to deliver care more efficiently,” the CHCF summary notes. The study is ongoing.
“Sounding Off on Medicaid’s ‘Big Difference’ in Quality of Life,” Andrew Villegas, July 7, on Capsules: the KHN Blog (published by Kaiser Health News, which is affiliated with the Kaiser Family Foundation). In this Blogwatch post, Villegas has a round-up of what other blogs (including the Wall Street Journal Health Blog, Mother Jones, and the National Review’s Critical Condition blog) have said about the NBER working paper.
“Oregon Medicaid Experiment: Not as Convincing as You May Think,” Paul Winfree, July 8, on the Foundry, the Heritage Foundation’s blog on conservative policy news. At the conclusion of his post, Winfree comments, “This debate needs to shift entirely away from comparing those on Medicaid to the uninsured. Instead, we need to know whether people on Medicaid have better or worse outcomes relative to those with private insurance coverage and whether the benefits are worth the ever-higher cost of Medicaid.”
Recent grant awarded:
The New York Community Trust recently awarded a $50,000 grant to Medicaid Matters New York to bring the consumer voice to Medicaid reform debates, according to its June 2011 newsletter. Medicaid Matters is a statewide coalition of more than 130 organizations (including the Visiting Nurse Service of New York, the William F. Ryan Community Health Center, and the American Diabetes Association). Its mission is to make sure policy makers see “the importance of Medicaid to low-income and medically-vulnerable New Yorkers” and see its effect on people. Lara Kassel, who is coordinator of Medicaid Matters, was among those appointed to New York Gov. Andrew M. Cuomo’s (D) Medicaid Redesign Team; other members include Kenneth E. Raske (president of the Greater New York Hospital Association), Mike Hogan (commissioner of the state’s Office of Mental Health), and Ann F. Monroe (president of the Community Health Foundation of Western and Central New York), according to a January press release from Cuomo’s office.
“Achieving Medicare and Medicaid Savings: Cutting Eligibility and Benefits, Trimming Payments, or Ensuring the Right Care?” by Karen Davis and Stu Guterman of the Commonwealth Fund on the Commonwealth Fund Blog, July 13. The authors look at three possible ways to cut spending on these entitlement programs and provide insights.
“Medicaid Spending Variations Driven More by Volume than Price, Says Study in new Health Affairs,” Chris Fleming on Health Affairs Blog, July 7. Fleming, who is social media manager at the journal, blogs on a July 2011 Health Affairs article by Todd P. Gilmer of the University of California, San Diego (UCSD) and Richard G. Kronick, now of the U.S. Department of Health and Human Services (HHS). (Kronick is on leave from UCSD while he serves in the Obama administration.) The authors’ work is the first study of its kind to examine state and regional differences in Medicaid spending, Fleming notes. The variation is wide. Gilmer suggests in the blog post that “by increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality [of care] while reducing Medicaid spending.” Changes in Health Care Financing and Organization (HCFO), an RWJF national program, funded the authors’ work.
“Agreement on Debt Talks: Health Groups Dislike Proposals,” Robert Pear, New York Times, July 12. Pear says that ideas on cutting Medicare and Medicaid put forth by those negotiating the federal budget “have managed to provoke opposition from almost every major group that represents beneficiaries and health care providers.”
“Report: Systems Designed to Catch Billions of Dollars in Medicare, Medicaid Fraud Inadequate,” Associated Press (published in the Washington Post), July 12. This article on a new Government Accountability Office (GAO) report says the federal systems “don’t even include Medicaid data” that could be analyzed to detect possible fraud.
“What a Debt Ceiling Deal Could Mean for Medicare, Medicaid, and Social Security,” Alec MacGillis, Washington Post, July 12. Among the questions addressed in this FAQ piece: “Are people going to be cut from the Medicaid rolls?”
Quality of Care
“Reinventing Medicaid: State Innovations to Qualify and Pay for Patient-Centered Medical Homes Show Promising Results,” Mary Takach of the National Academy for State Health Policy (NASHP), Health Affairs, July 2011. Takach describes patient-centered medical home initiatives in seventeen states. In the medical home model of primary care, a team, led by a primary care provider, tends to the varied needs of patients and provides “whole-person, comprehensive, coordinated, and patient-centered care.” Although the initiatives are still in their infancy, “early results are encouraging,” Takach states. The Commonwealth Fund supported this research.
New York Medicaid
“Medicaid in New York: The Road Ahead,” Michael Birnbaum of the United Hospital Fund, April 13 presentation at the David Rogers Health Policy Colloquium, a weekly event at Weill Medical College of Cornell University. (By the way, according to the Medical Center Archives of New York Presbyterian/Weill Cornell, the late David Rogers was the first president of the RWJF and the son of the well-know psychiatrist Carl Rogers.) Included in Birnbaum’s PowerPoints was the startling statistic that spending for the elderly and disabled category of New York Medicaid beneficiary has increased by 60 percent in the 2000–2010 period. Among the United Hospital Fund’s major initiatives is its Medicaid Institute, which Birnbaum directs as part of his work at the fund.
What improvements are needed for New York Medicaid so that it can be integrated with the health insurance exchange being designed for the state (as part of federal health reform)? On May 16 the United Hospital Fund released a report exploring that topic, funded by the New York State Health Foundation. The report, by Danielle Holahan, is titled Coordinating Medicaid and the Exchange in New York. See the “Consumer Communications” section and a useful timetable of key dates in the countdown to January 2014, when various provisions of the Affordable Care Act are supposed to be up and running.
Medicaid Prescription Drug Costs
“Alabama Cuts Medicaid Drug Costs by Examining Pharmacy Receipts,” Christine Vestal on the Pew Charitable Trusts’ Stateline.org (a nonpartisan online news service), July 14. This state in the Deep South found that it pays to scrutinize pharmacy receipts, Vestal reports. The Alabama Medicaid director aimed to attack “fraudulent prices published by major drug makers.” Alabama has now come up with a new pricing method for meds paid for under Medicaid and got federal approval for it. A few months later, Oregon got approval to use the same method. Both states are sensitive to local pharmacies’ need to make a profit. Now HHS “is urging other states to add Alabama’s pricing model to their arsenals of ways to cut Medicaid costs,” the article notes.